The title of her book, Drinking: A Love Story, by Caroline Knapp, succinctly captured the essence of the late author’s gradual descent into alcoholism. The end point of this tragic journey lies at the far right end of the drinking spectrum, depicted below. In order to get to that final stage, however, Ms. Knapp had to first pass through two other areas that define problem drinking, including a large gray zone that until now has received little attention. This is the “almost alcoholic” zone, and helping people to identify at what point they may have slipped into this zone offers them an opportunity: to pause, reflect, and ultimately to decide if they want to pursue solutions for turning back.
Three kinds of “relationship”
One way that we have found useful in terms of thinking about the different zones in the diagram is in terms of different degrees of relationship. Just as our interpersonal relationships can differ in terms of intensity, so can our “relationship” with drinking. Moreover, these differences aren’t separated by sharp lines; rather, they tend to blend into one another. Let’s look at these different kinds of relationships.
“Casual friendship“
People whose relationship with alcohol falls into this stage drink primarily in social settings. This is what we mean by “normal social drinking.” It’s a glass or two of wine at a wine-and-cheese get-together among friends, a couple of beers at the Sunday afternoon football party with friends, or an occasional happy hour cocktail with people from work. If we do drink alone at this stage of use, it is not typically on a daily basis, and it involves only a drink or two in one sitting.
Social users never binge, and they are neither psychologically nor physically “dependent” on drinking, for example, in order to overcome social anxiety. People have used alcohol socially — indeed, it has been called a “social lubricant” — for literally centuries. Drinking in this context is said to help people “loosen up” or “relax.” Indeed, in small quantities alcohol may do this. A glass of wine or a beer can take the edge off just about any common stress we may be feeling. It can lower our inhibitions us just a bit (hence the term “unwind”), and thereby facilitate social interaction. Negative consequences, of course, can occur at any stage of drinking, but they are relatively rare at this stage. Viewed in terms of a relationship, at this stage alcohol can best be thought of as a casual friend. In terms of the drinking spectrum, a casual friendship with alcohol falls at the left end.
“Relationship”
When we say we’ve gone from being casual friends with someone to having a “relationship” with them we are implying a stronger connection. So it is with alcohol. In this second stage, a person has learned to use alcohol consistently for one of two reasons: either to create certain positive feelings (e.g., relaxation, euphoria) or else to avoid certain negative feelings (e.g., anxiety, loneliness).
This type of drinking is represented by the large gray area that we have defined as the “almost alcoholic” zone on the drinking spectrum. It is indeed a “gray area” because, first, there is no sharp line that separates normal social drinking from becoming an almost alcoholic. Second, there are even degrees within that zone, with some people being much closer to true alcoholism than others. In other words, as a person moves to the right on the drinking spectrum the stronger their “relationship” with alcohol becomes.
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The opinions expressed in this post are those of the authors. They do not purport to reflect the opinions or views of the FASD Prevention Conversation Project, its stakeholders or funders.